Registration Form
Registration Form
First name
*
Last name
*
Hospital or Institute
*
This info will appear on your personal name tag
Email
*
Mobile phone number
*
Dietary wishes (optional)
BIG-number (Dutch participants)
What is your skills level?
Basic
Intermediate
Advanced
What is your background?
Neurologist
Radiologist
Different
Different - Please specify
Participation
Promotional code (optional)
Conference participation
Conference participation - € 1.050 ex VAT
Single day - Wednesday September 3 - € 600 ex VAT
Single day - Thursday September 4 - € 600 ex VAT
Single day - Friday September 5 - € 600 ex VAT
Conference dinner
Conference dinner Wednesday - € 55 ex VAT
Conference participation - Code
Participation - Wednesday September 3
Conference dinner - Wednesday September 3
Participation - Thursday September 4
Participation - Friday September 5
Hotel Fletcher Nieuwegein - Single
Hotel Room - Tuesday September 2 - € 135
Hotel Room - Wednesday September 3 - € 135
Hotel Room - Thursday September 4 - € 135
Hotel Room - Friday September 5 - € 135
Hotel Fletcher Nieuwegein - Double
Hotel Room Double - Tuesday September 2 - € 157
Hotel Room Double - Wednesday September 3 - € 157
Hotel Room Double - Thursday September 4 - € 157
Hotel Room Double - Friday September 5 - € 157
Hotel Fletcher Nieuwegein - Code
Hotel Room - Tuesday September 2
Hotel Room - Wednesday September 3
Hotel Room - Thursday September 4
Subtotal
€ 0,00
VAT (21%)
€ 0,00
Total Amount
Conference Participation
Price:
Conference Dinner - Wednesday
Price:
Conference Dinner - Wednesday
Price:
Single day - Wednesday September 3
Price:
Single day - Thursday September 4
Price:
Single day - Friday September 5
Price:
Single day code - Wednesday September 3
Price:
Single day code - Thursday September 4
Price:
Single day code - Friday September 5
Price:
Hotel Fletcher - Tuesday September 2 (0% VAT)
Price:
Hotel Fletcher - Wednesday September 3 (0% VAT)
Price:
Hotel Fletcher - Thursday September 4 (0% VAT)
Price:
Hotel Fletcher - Friday September 5 (0% VAT)
Price:
Hotel Fletcher Double - Tuesday September 2 (0% VAT)
Price:
Hotel Fletcher Double - Wednesday September 3 (0% VAT)
Price:
Hotel Fletcher Double - Thursday September 4 (0% VAT)
Price:
Hotel Fletcher Double - Friday September 5 (0% VAT)
Price:
Hotel Fletcher code - Tuesday September 2
Price:
Hotel Fletcher code- Wednesday September 3
Price:
Hotel Fletcher code - Thursday September 4
Price:
Invoice Details
Company or Institute
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Department / Contact person (optional)
Address
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Postal Code
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City
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